JICS Education: Death in intensive care. Pathophysiology and diagnosis

Death is a daily reality of intensive care medicine and its safe and timely diagnosis is a core competency for the intensive care physician. This article addresses the philosophical and physiological basis of death as a neurological event and the history of its clinical recognition. The pathophysiology of coning, including the systemic consequences that follow neurological death are addressed in detail along with the maintenance of haemodynamic stability to allow brain stem testing. The clinical diagnosis of death using somatic, circulatory, and neurological criteria, including the updated 2025 Academy of the Medical Royal Colleges (AoMRC) Code of Practice and specific guidance for patients supported by extracorporeal membrane oxygenation (ECMO), is explored to give FCICM exam candidates the knowledge necessary for the exam.